Dermbusters

In this episode of Dermbusters, host Nicholas Brownstone, MD, and guest Dr Gabriela Maloney, DO, tackle common dermatologic myths often heard from their patients. Dr Maloey provides practical advice for clinicians to effectively counsel patients on 2 key topics: the link between diet and acne and the belief that sunscreen applications leads to vitamin D deficiency. Myth 1: Fried foods and chocolate increase the risk of acne Dr Maloney addresses the long-standing belief that diet, particularly fried foods and chocolate, plays a significant role in acne development. Historically, a 1969 study concluded that there was no direct link between acne and diet, which shifted the focus away from dietary factors. However, recent studies have revisited this topic, with some suggesting that foods high in glycemic index and fat content might exacerbate acne. Specifically, interventional studies have indicated that reducing glycemic load can potentially decrease inflammation and acne severity. Tips for counseling patients: Focus on glycemic index: Advise patients to pay attention to their diet’s glycemic index, which may be more relevant to acne management than specific foods like chocolate or fried items. Encourage a healthy diet: Recommend a balanced diet while still allowing flexibility for individual preferences, such as gluten-free or keto diets. Follow treatment plans: Emphasize the importance of adhering to prescribed acne treatments, as dietary changes alone are unlikely to resolve acne completely. Myth 2: Wearing sunscreen leads to vitamin D deficiency A common concern is that sunscreen use can lead to vitamin D deficiency. Dr Maloney explains that this fear should not prevent patients from using sunscreen and highlights that diet plays a crucial role in maintaining adequate vitamin D levels. Tips for counseling patients: Emphasize the role of diet: Explain that vitamin D can be adequately obtained through a balanced diet, eliminating the need to forego sunscreen. Highlight the risks of sun exposure: Stress that the risk of skin cancer from sun exposure outweighs the risk of vitamin D deficiency from using sunscreen. Tune in to the episode to hear Dr Maloney and Dr Brownstone provide valuable insights for dermatologists to guide patients more effectively and counter common misconceptions.

In this episode of Dermbusters, host Nicholas Brownstone, MD, sits down with Brandon Adler, MD, to address some common misperceptions they often hear from their patients. Dr Adler shares how he tackles 2 pressing concerns that dermatologists frequently encounter from their patients: the efficacy and safety of natural products, and the concerns surrounding ingredients in sunscreens. Myth 1: Natural products are always better There is a growing trend among patients towards seeking out natural products, both homemade and store-bought, with the belief that they are inherently better and safer than traditional products. Drawing from his experience running a contact dermatitis clinic, Dr Adler shares that he often sees patients who develop allergic reactions to natural ingredients, such as essential oils. Tips for counseling your patients: Explain that studies demonstrate the rates of contact allergy and irritation are at least comparable between natural and traditional products Mention that while natural products can be effective, each patient is unique and may develop sensitivities or allergies to certain ingredients Dispel the belief that natural always equals good; to illustrate the point effectively, share an analogy relating natural products to poison oak, which, while natural, is not something you want on your skin Myth 2: Harmful ingredients in sunscreens outweigh its benefit Many patients voice concerns about harmful ingredients in sunscreens, with some avoiding sunscreen use altogether to mitigate risks. Dr Adler shares a few tips on how he talks to patients on this issue. Tips for counseling your patients: Explain that while chemical or organic blockers found in many sunscreens have been shown in studies to be systemically absorbed into the body, there is no evidence of any associated adverse effects to date, and these agents have been used safely for decades For patients still concerned about systemic absorption, recommend zinc- and titanium-based physical or mineral sunscreens, which have not shown to be absorbed and therefore don’t carry the same potential implications as chemical blockers For patients with environmental concerns, physical sunscreens can also be recommended Emphasize that the risk of skin cancer is significantly greater than the potential risk of harmful ingredients in sunscreens Tune in to the episode to hear Dr Adler’s approach to individualized patient care and hear his practical solutions for addressing common patient concerns.

In this episode of Dermbusters, host Nicholas Brownstone, MD, chats with acne and rosacea expert Emmy Graber, MD, MBA, about some common misperceptions they often hear from their patients. Dr Graber shares some tips on counseling patients on 2 topics: how diet impacts acne and advising patients on isotretinoin to wait 6 to 12 months before getting cosmetic procedures. Myth 1: Fried and fatty foods cause acne. Dr Graber addresses the widespread belief among patients that fried and fatty foods can induce acne. She acknowledges the challenges of studying diet’s impact on acne but shares a few tips on counseling patients based on published data. Tips for counseling your patients: Explain to patients that while some studies suggest a correlation between high-glycemic foods and acne for some individuals, the association is not universal Emphasize the role of dairy products, particularly skim milk products, in exacerbating acne for some patients For patients who can identify specific dietary triggers, give them the option of avoiding that food Emphasize the uniqueness of individual responses to dietary triggers rather than making blanket statements Myth 2: Patients must wait at least 6 months following the use of isotretinoin before having any cosmetic or surgical procedures. Dr Brownstone and Dr Graber then discuss advising patients on isotretinoin on the often-recommended waiting period before undergoing any cosmetic or surgical procedures. Dr Graber challenges the traditional notion of waiting 6 to 12 months, relating a few discussion points to share with patients. Tips for counseling your patients: Cite a systematic review of over 32 studies and 1400 procedures1 that found no evidence supporting the need for a prolonged delay for cosmetic procedures following isotretinoin use Advise patients that procedures like visible light lasers, hair removal, superficial chemical peels, and fractional and ablative lasers are safe while on isotretinoin Counsel patients to follow the waiting period and delay more intense procedures like nonfractional lasers, deep dermabrasions, and deep chemical peels until there is more data available to support the safety of such procedures while on isotretinoin Mention potential benefits of pulsed dye laser treatments for acne for patients concurrently on isotretinoin, noting not only safety but potentially improved outcomes Tune in to the episode to hear the full details on Dr Graber’s informed approach to counseling patients that embraces evidence-based practices to optimize care. Reference Spring LK, Krakowski AC, Alam M, et al. Isotretinoin and timing of procedural interventions: a systematic review with consensus recommendations. JAMA Dermatol. 2017;153(8):802-809. doi:10.1001/jamadermatol.2017.2077

In this episode of Dermbusters, host Nicholas Brownstone, MD, sits down with Katherine Glaser, MD, a dermatologic surgeon specializing in Mohs surgery, about some common misperceptions heard from both colleagues and patients. Dr Glaser shares some insights on 2 frequently misunderstood topics: the use of lidocaine with epinephrine in the fingers and toes and the role of sunscreen in vitamin D absorption. Myth 1: Dermatologists should not use lidocaine with epinephrine in the fingers and toes. Contrary to a commonly held belief among dermatologists, Dr. Glaser emphasizes that there is robust data supporting the safe use of lidocaine with epinephrine in the fingers and toes. Despite concerns about vascular ischemia and resulting necrosis, studies from both dermatology and plastic surgery literature demonstrate the safety of lidocaine with epinephrine. Tips for advising colleagues: Share the existing data and research findings that support the safe use of lidocaine with epinephrine in the fingers and toes Highlight the lack of reported cases of ischemia with traditional lidocaine with epinephrine and contrast it with cases involving other substances, high concentrations of epinephrine, and improper tourniquet use Emphasize the importance of adhering to safe injection practices, proper dosage, and avoiding direct arterial injection to mitigate any potential risks Myth 2: Sunscreen should not be used because it prevents absorption of vitamin D. Next, Dr Glaser addresses a common myth that dermatologists often hear from their patients: that they shouldn’t use sunscreen because it prevents them from absorbing an adequate amount of vitamin D. While sunscreen does block the UVB rays that aid in vitamin D synthesis, the AAD advises against UV exposure solely for the purpose of absorbing vitamin D. Tips for counseling your patients: Explain that while sunscreen may affect vitamin D absorption, it's not a reason to skip it Highlight alternative sources of vitamin D, such as diet and supplements Encourage wearing sunscreen consistently and correctly Stress the importance of protecting the skin from harmful UV rays to prevent skin damage and reduce the risk of skin cancer

In this episode of Dermbusters, host Nicholas Brownstone, MD, chats with Cheri Frey, MD, about some common misperceptions they often hear from their patients.Dr Frey shares some suggestions on how to counsel patients on 2 significant topics: retinol use for patients with sensitive skin and moisturizing for patients with acne.Myth 1: Patients with sensitive skin can’t use retinol for acne.Dr Frey addresses a common myth that dermatologists often hear from their patients: that they shouldn’t use retinol to treat acne if they have sensitive skin. She offers a few suggestions for dispelling this misperception when speaking with patients.Tips for counseling your patients:Advise eligible patients to try an over-the-counter retinol that’s not as strong or harsh as prescription-strength retinoidsExplain application strategies such as the sandwich method, which involves applying retinol between 2 layers of moisturizer, and short-contact application, where retinol sits on the skin for a few minutes before being washed offExpress the importance of retinol as a cornerstone of acne treatment and reassure patients there is always a way to incorporate it as a therapyMyth 2: Patients with acne can’t moisturize their skin.Dr Brownstone and Dr Frey next cover another common myth often heard from patients: that moisturizing can exacerbate acne.Dr Frey stresses the importance of moisturization for patients with acne and serves up a few tips to use in patient conversations when addressing this topic.Tips for counseling your patients:Explain the barrier disruption that occurs in patients with acne and how it can cause more irritation and inflammation; advise patients that moisturizing can mitigate this disruption to the top layer of skinEducate patients on the drying nature of retinols and other acne-fighting ingredients; emphasize the importance of keeping skin hydrated so patients can tolerate their acne medications

In this episode of Dermbusters, host Nicholas Brownstone, MD, chats with Anthony Rossi, MD, about some common misperceptions they often hear from their patients. Dr Rossi shares some suggestions on how to counsel patients on 3 significant topics: a misconception surrounding higher-percentage medications, the proper use of facial cleansers, and the necessity of wearing sunscreen during the winter months. Myth 1: Higher-percentage ingredients mean a medication is more efficacious. Dr Rossi begins by addressing the prevalent belief that higher percentages of ingredients in medications indicate greater efficacy. Contrary to this notion, he emphasizes that the right amount, rather than the highest percentage, is the key to achieving optimal results. Patients are advised to focus on key or active ingredients, striking a balance between not being the first or last listed in a formulation. Striving for a middle ground ensures effectiveness without causing unnecessary irritation. Tips for counseling your patients: Advise them to look at their product’s ingredient list. The active ingredient should neither be the first nor the last listed. Being the first suggests it's the highest percentage, while being the last indicates it's the lowest. Suggest they aim to find a product with the active ingredient listed somewhere in the middle. Caution them that certain ingredients, such as vitamin C, can actually be irritating in higher concentrations. Myth 2: You must wash your face for 60 seconds for maximum effectiveness. Dr Rossi supports this popular notion that washing the face for at least 60 seconds maximizes impact, with one important caveat: water alone is not an effective cleanser. He emphasizes the importance of a good cleanser and advises patients to focus on contact time; he recommends keeping cleanser on the face for at least 60 seconds to allow the active ingredient to work. Tips for counseling your patients: Advise patients not to wash with water alone, especially if they wear makeup or live in an urban environment and are exposed to daily pollution. Suggest they apply their cleanser, let it become sudsy, then brush their teeth before washing it off. This ensures the cleanser is making contact with their skin for at least one minute. Myth 3: Sunscreen isn’t necessary in the winter. Next, Dr Rossi addresses a myth that dermatologists hear often: sunscreen isn’t necessary in the winter or on cloudy days. Dr Rossi underscores that significant amounts of both UVA and UVB rays can still reach the skin even in the winter months and that sun protection is still important. Tips for counseling your patients: Show them images from the New England Journal of Medicine article “Unilateral Dermatoheliosis” by Gordon et al, which showcases photoaging on one side of a truck driver’s face and serves as an impactful visual aid that UVA can be transmitted through window glass.Explain that the light reflection from snow can amplify sun exposure when engaging in outdoor winter activities. Advise them to look for a sunscreen that offers both an SPF of 30 or higher and UVA protection.

In this episode of Dermbusters, our host, Nicholas Brownstone, MD, chats with Daniel Butler, MD, to discuss how he counsels patients who come to him with some common misperceptions dermatologists often hear. In this installment, Dr Butler addresses myths on scalp massage for baldness and contact dermatitis arising from deodorant use. Can scalp massage help prevent baldness? One common misperception dermatologists often hear from their patients is the belief that increasing blood flow to the scalp via scalp massage can prevent baldness. Dr Butler advises patients on the complexity of hair growth, emphasizing that just increasing blood flow to the scalp is not a cure-all for hair loss. He notes that there are some small studies that suggest scalp massage may marginally increase hair thickness; however, he clarifies that this does not equate to a viable solution for those with androgenic alopecia. Can deodorant cause contact dermatitis? Another common query from patients is whether deodorant can trigger contact dermatitis. Dr Butler addresses this concern by acknowledging that certain deodorants can indeed lead to contact dermatitis, but he emphasizes the importance of ruling out other potential causes for rashes before attributing them solely to deodorant use. Importantly, he reassures patients who don’t have existing rashes that using deodorant or antiperspirant should not be a cause for concern. When we get rashes in the armpits, patients often question what’s touching them there that can cause it. Some deodorants have been known to cause contact dermatitis, but there are other things that need to be ruled out first and foremost. If you have a rash in that area, it’s important to know that deodorant can be contributing to that. However, if you don’t have a rash and you’re using a deodorant or antiperspirant, don’t worry that it will then cause contact dermatitis.

Join Dr Nick Brownstone in this episode of Dermbusters, where he chats with Dr Elizabeth Swanson to address some common misperceptions surrounding the use of Accutane that they often hear from both colleagues and patients. Are monthly labs for Accutane needed for safety? No. Dr Swanson notes that she has been in practice for over 12 years, and when she was in training, providers did do labs every month for patients taking Accutane, including a liver function test, a lipid panel, and sometimes a CBC. Since she’s been practicing, the guidelines for Accutane have recommended less and less monitoring over time. She references an article published in JAMA Dermatology that recommended testing only for alanine aminotransferase (ALT) and triglycerides at baseline and again at 2 months or after peak dose is reached. Dr Swanson comments that testing only twice for 2 things is great news for patients. Dr Brownstone asks Dr Swanson how she counsels patients when they want additional labs performed to ensure the medication isn’t causing side effects. She remarks that her patients never request that, and she generally finds they are very pleased to only need minimal blood draws for monitoring. Does Accutane increase the risk of suicidal behavior or depression? Dr Swanson notes that this is a very controversial topic. When she addresses this with her patients and their families, she explains that there were some initial concerns about suicidal behavior and depression in patients with Accutane, but because of these concerns, it has been extensively studied in tens of thousands of patients. Those studies found that most patients actually notice an improvement in their mood due to clearer skin and improved self-esteem and confidence. As a pediatric dermatologist, Dr Swanson prescribes Accutane daily; she reassures her patients and their families that in her years of practice, she has had only 6 patients who exhibited signs of depression and had to stop the medication. She concludes by noting that while these side effects do occur rarely, the studies support patients seeing an improvement in their mood.

In this installment of Dermbusters, Dr. Nick Brownstone sits down with Dr. G. Michael Lewitt to get his thoughts on blood monitoring for patients prescribed biologics and to discuss how he advises patients who believe tretinoin must be applied at night. Do dermatologists have to check CBCs and LFTs with all biologics? Dr. Lewitt explains that from looking at the data, it’s likely not necessary to monitor CBCs and LFTs for patients who are prescribed a biologic. He estimates that half of the biologic prescribers across the US do this type of monitoring for patients taking a biologic, and the other half do not. He recalls that when the IL-17s came out, there were a few incidences of neutropenia and leukopenia observed which led to a trend of blood monitoring every 6 months; however, he then found he did not see any more abnormalities across the following 2 years and felt that as a result, this type of monitoring was wasting his time and patients’ healthcare funds. He now checks CBCs and LFTs annually for patients taking a biologic. When counseling his patients on this topic, he emphasizes to them that they have a chronic skin condition and should receive age- and disease-state-appropriate blood monitoring, like TSH and fasting limit profiles, at intervals recommended by their primary care physicians. In sum, he emphasizes that the necessity of checking CBCs and LFTs for patients taking a biologic is largely a myth. Do topical retinoids have to be applied at night? Dr. Lewitt explains that of the 4 current generations of retinoids, the original tretinoin and tretinoin derivates were photolabile, while generations 2 though 4 are photostable. Historically, patients were encouraged to apply retinoids at night because as soon as they were exposed to sun in the morning, the medication became inactivated. Even though the newer generations of retinoids are photostable, Dr. Lewitt still prefers nighttime application. With the most common side effect being retinoid dermatitis or irritation, he finds that with evening application, he can then troubleshoot in the mornings to ensure there isn’t any scale appearing on his nose or eyes. However, from a pharmacodynamic standpoint, generations 2 though 4 do not need to be applied at night. He advises his patients that the best time to apply it is whenever they can best remember and recommends applying it at the same time they brush their teeth to establish a routine.

Do patients with skin of color need sunscreen?First, Dr. Brownstone asks Dr. Elston how to advise patients with skin of color who believe they don’t need sunscreen. Dr. Elston references studies that show not only do patients with skin of color get skin cancer, they also tend to get diagnosed later and have higher mortality.She details a study that examined melanoma survival among White, Hispanic, Asian, and Black women, which demonstrated that those with skin of color had lower survival rates, with Black women having the lowest.To encourage sunscreen use among her patients with skin of color, Dr. Elston recommends products that will be more cosmetically favorable on pigmented skin; some of the physical blockers can be challenging, so she often recommends sunscreens that are in a clear- or a gel-base that will rub in.If a topical medication isn’t burning, does that mean it’s not working?Next, Dr. Brownstone chats with Dr. Elston on a common misperception heard from patients—if a topical medication isn’t burning, it isn’t working.Dr. Elston explains that many medications burn or sting because of what’s in the vehicle, like lactic acid affecting patients who are sensitive to cosmetic products or propylene glycol causing an irritant effect. She explains to patients that the resulting stinging is not a result of the products’ efficacy. She also explains that other drugs cause burning because of the drug effect, for example, topical calcineurin inhibitors causing a capsaicin-like burning reaction that often gets better the longer patients use them. She helps dispel this common misconception by advising patients that these medications work just as well when the burning stops.

In this episode of Dermbusters, Dr. Nick Brownstone chats with Dr. Aaron Farberg how he busts myths often heard from patients surrounding sunscreen use and scarring.Is a higher SPF sunscreen always better?First, Dr. Brownstone asks Dr. Farberg how he counsels patients who believe a higher SPF sunscreen is always better. Dr. Farberg explains that when he chats with patients about sunscreen use, he emphasizes that the best sunscreen is whichever one they will use consistently.He tells his patients that an SPF of 30 is sufficient if they are using it correctly; however, he notes that most people do not, either by not applying enough or not reapplying their sunscreen. Considering that, he advises his patients to select the highest SPF sunscreen they can find to give themselves a margin of safety.Is a barely noticeable scar the mark of a good surgeon?Next, Dr. Brownstone inquires about a misconception regarding scarring that he often hears from patients: that a barely noticeable scar is the mark of a good surgeon. Dr. Farberg emphasizes that for patients who hold this belief, managing expectations is key and advises them that they should expect a scar.He describes his system of measuring scars by distance—whether the scar is visible from 3 feet, 30 feet, or 300 feet—and that he explains to his patients that he aims for scars that can only be visible from 3 feet away.

In this episode of Dermbusters, Dr. Nick Brownstone asks Dr. Dawn Sammons how she dispels myths often heard from patients about tanning and tretinoin use.Does a base tan prevent sunburn?First, Dr. Brownstone asks Dr. Sammons what she says to patients who believe getting a base tan prevents sunburn and the need for sunscreen. She explains to her patients that while a base tan may provide a very slight level of SPF, it does not prevent the need for sunscreen, and pretanning ultimately increases the amount of sun damage patients get. For patients still desiring the look of a base tan, she advises a spray tan. She notes that with social media often promoting misconceptions about base tans, dermatologists must work to help dispel these notions among their patients.Does tretinoin make you more sun-sensitive?Next, Dr. Brownstone chats with Dr. Sammons on the belief that tretinoin makes the skin more sun-sensitive. She states that while true, the slight decrease in minimum effective dose associated with topical retinoid use is not time-sensitive, and that skin won’t be any more sensitive in the daylight hours than in the evening. Considering this, she questions the reasoning dermatologists have for instructing patients to apply retinoid at night. Dr. Sammons explains that she encourages patients to apply their retinoid at whatever time they are most likely to adhere to. In her experience, her younger patients tend to have more consistent routines in the morning as opposed to at bedtime.She concludes by explaining that historically, retinoids were photolabile and thus deactivated by sunlight. As a result, dermatologists instructed patients to apply retinoids at night. Currently, however, all preparations are micronized and photostable for up to 8 hours, which is sufficient time for retinoid to be absorbed.